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    Anticoagulation therapy in pregnant women with mechanical heart valve
    (Bayçınar Medical Publishing, 2018) İşcan, Hakkı Zafer; Hanedan, Muhammet Onur; Özen, Anıl; Diken, Adem İlkay; Başar, Veysel; Ünal, Ertekin Utku; Birincioğlu, Cemal Levent
    Background: This study aims to investigate the effects of various anticoagulant regimens on prosthetic valve-related complications and pregnancy outcomes including feto-maternal mortality and morbidity, and to identify the most optimal anticoagulation therapy regimen. Methods: Anticoagulant therapy regimens for pregnant women who underwent mechanical heart valve replacement between January 1990 and December 2015 was analyzed retrospectively. Seventy-two pregnancies among 57 patients after mechanical heart valve replacement were reviewed, and four different regimens were identified and evaluated during different trimesters of pregnancy. Results: Forty of 72 pregnancies resulted in healthy newborns; 35 (48.6%) healthy neonates, four (5.6%) premature births, and one (1.4%) low birth weight. Eighteen (25%) therapeutic and 12 (16.7%) spontaneous abortions, as well as two (2.8%) stillbirths occurred. Seven valve thromboses developed during pregnancy or the postpartum period. Bleeding occurred in six patients (10.5%) and peripheral embolism also occurred in six patients (10.5%). No maternal mortalities were recorded. Conclusion: Although there is no consensus on the most optimal anticoagulant regimen during pregnancy, substituting warfarin with dose-adjusted unfractionated heparin or low-molecularweight heparin seems suitable to prevent teratogenicity and a high abortion rate in the first trimester. Low-molecular-weight heparin is practical to use and can be monitored reliably, resulting in successful pregnancy outcomes. However, warfarin throughout pregnancy ?5 mg per day may be an alternative choice, if the risk of embryopathy is accepted by the pregnant woman. © 2018 All right reserved by the Turkish Society of Cardiovascular Surgery.
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    Rivaroxaban vs. warfarin on extended deep venous thromboembolism treatment: A cost analysis
    (SAGE Publications Ltd, 2018) Diken, Adem İlkay; Yalçınkaya, Adnan; Hanedan, Muhammet Onur; Erol, Mehmet Emir; Erçen Diken, Özlem
    Background: Standard treatment for deep venous thromboembolism involves parenteral anticoagulation overlapping with a vitamin K antagonist, an approach that is effective but associated with limitations including the need for frequent coagulation monitoring. The direct oral anticoagulant rivaroxaban is similarly effective to standard therapy as a single-drug treatment for venous thromboembolism and does not require routine coagulation monitoring. The aim of this analysis was to project the long-term costs and outcomes for rivaroxaban compared to standard of care (tinzaparin/warfarin). Methods: A total of 184 patients who were under anticoagulant therapy with warfarin or rivaroxaban for extended deep venous thromboembolism were retrospectively evaluated; 59 received rivaroxaban and 125 received warfarin therapy. Assessments were made on age, gender, place of residence, the duration of anticoagulation, mean international normalized ratio value, the effective rate of international normalized ratio (time in the therapeutic range), bleeding-related complication rate, duration of hospitalization due to complications, the number of annual outpatient department admission, cost for drug, cost for hospitalization, cost for outpatient department admission and international normalized ratio measurements. Results: The annual outpatient cost is higher in warfarin group (147.09 ± 78 vs. 62.32 ± 19.79 USD p < 0.001). But annual drug cost is higher in rivaroxaban group (362.6 vs. 71.55 ± 31.01 USD p < 0.001). Overall cost of rivaroxaban group is higher than warfarin group (476.25 ± 36.78 vs. 364.82 ± 174.44 USD). Warfarin is not cost-effective when non-drug costs (342.5 ± 174.44 vs. 113.65 ± 36.77) and hospital costs (173.85 ± 122.73 vs. 64.9 ± 23.55 USD) were analyzed. Conclusion: This analysis suggests that rivaroxaban has lower costs than warfarin in terms of outpatient department admission and hospital costs due to complications; however, warfarin was more economic when all cost parameters were considered. Time in the therapeutic range was found as 56% for warfarin that should be taken into account while analyzing costs and benefits. © The Author(s) 2017.
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    The predictive role of computed tomography on respiratory complications following coronary artery bypass surgery
    (Derman Medical Publishing, 2018-09) Erçen Diken, Özlem; Diken, Adem İlkay; Yalçınkaya, Adnan; Özyalçın, Sertan; Hanedan, Muhammet Onur
    Aim: Pulmonary complications are frequently seen complications following especially after coronary artery bypass grafting. Attempts are made to detect those complications preoperatively by pulmonary function tests and clinical evaluation. In our study, we investigated the effect of computed tomography findings in predicting postoperative complications in patients with normal respiratory function tests. Material and Method: Between January 2012 and August 2017, imaging records, intensive care and service follow-up records, and policlinic follow-up records of 695 patients who underwent elective isolated CABG at the Department of Cardiovascular Surgery in Hitit University Faculty of Medicine were retrospectively reviewed. Computed tomography images, demographic, and clinical data of the patients who met the inclusion criteria were retrospectively evaluated. Results: Mediastinal lymphadenopathy, emphysema, interlobular septal thickness/fibrosis, nodule, pleural thickening, tuberculosis sequel, and band/subsegment alatelectasis parameters were evaluated. The most common preoperative radiologic pulmonary pathology was mediastinal lymphadenopathy (n=96, 27.3%), and the least was tuberculosis sequel (n=20, 5.6%). The most common pulmonary complication in the postoperative period was atelectasis (148 patients, 42%). On logistic regression analysis, emphysema was found to be a significant predictor of both prolonged mechanical ventilation and bronchospasm (p<0.05). Furthermore, band or subsegmental atelectasis were also predictive for postoperative hypoxemia (p<0.05). Discussion: It can be claimed that pulmonary complications are observed frequently after CABG in patients even with normal respiratory function in the preoperative period; morphologic data of lungs obtained by computerized tomography in these patient groups may be predictive for some of the postoperative complications..